NCDR Study Supports Wider Use of Radial Catheterization

A major observational study of transradial access for PCI in patients with acute STEMI showed that over the five-year study period, radial access had slightly longer door-to-balloon time than femoral access, but showed lower bleeding rates and reduced in-hospital mortality, according to a study published Dec. 19 in the Journal of the American College of Cardiology.


Using 90,879 patients from 541 reporting sites within the NCDR's CathPCI Registry®, authors found that while the total use of TRI (transradial PCI) is low, transradial access increased significantly, from 0.9 percent to 6.4 percent over the five years of the study period (p<0.0001). Vascular complications requiring procedural care were less common in TRI patients, 0.13 percent versus 0.49 percent for femoral PCI (FPCI) patients (p<0.001). There was no difference in procedural success between the two access routes, but TRI carried an odds ratio of 0.62 for bleeding and 0.76 for in-hospital mortality compared to FPCI. The one area in which FPCI outperformed TRI was median door-to-device time, 74 minutes for FPCI versus 78 minutes for TRI (p<0.0001). It is not clear whether the four-minute difference is clinically significant.

TRI has been shown to reduce post-procedural bleeding and major vascular complications in settings outside acute STEMI. But studies of TRI in acute STEMI have reported conflicting results. While PCI offers better outcomes for STEMI patients compared to thrombolytic therapy, bleeding and other access site complications complicate therapeutic decision-making. Radial access is of great interest in STEMI because it substantially reduces access site bleeding compared to femoral access.

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"Although the rate of adoption of radial access for emergent PCI in the U.S. is low, there is a trend of its increased use," wrote lead author Dmitri Baklanov, MD, Saint Luke's Mid America Heart Institute, Kansas City, Mo. "There was an association between TRI and reduced in-hospital mortality in patients with STEMI undergoing PCI. There was also a significant association with reduced bleeding in the TRI group." "These data suggest that wider adoption of TRI for STEMI may significantly improve outcomes," Baklanov concluded. "However, these results should be confirmed in an adequately powered prospective randomized trial."

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